India’s Mental Health Challenge

The MINDS Foundation partnered with Dhiraj General Hospital in Vadodara, Gujarat.

The MINDS foundation

In 2010, Raghu Appasani was in the eastern Indian state of Bihar volunteering with Unite for Sight, when his cousin in the southern state of Andhra Pradesh was diagnosed with epilepsy.

“My volunteer work opened my eyes to what I had previously been sheltered from — the huge gaps between urban and rural healthcare in India. At the same time, my cousin’s diagnosis put me at the frontline of social stigma and the lack of resources available for mental health,” said Mr. Appasani, an American of Indian origin.

He started the MINDS Foundation, a non-profit that provides educational, medical, and moral support for patients with mental health illness in rural India.

Minoo Ramanathan, third from left, conducts research in Vadodara, Gujarat.

The MINDS foundation

India lacks an officially approved mental health policy and has only 0.3 psychiatrists for every 100,000 people, the World Health Organization’s Mental Health Atlas 2011 says. The government spends 0.06% of its health budget on mental health, according to the WHO.

The Mental Health Care Bill, introduced in Parliament in August though not yet passed, is a welcome first step in expanding the country’s mental health infrastructure, Mr. Appasani says. Among its provisions, the bill aims to protect the rights of the mentally ill and improve their access to treatment through the establishment of central and state mental health authorities.

Social stigma remains an obstacle to helping Indians cope with mental health illness. “The attitude toward mental health in India is very different from the one in the West. It’s ‘something is wrong with you and it’s your fault,’ instead of ‘this is a medical problem and can be treated,’” said Minoo Ramanathan, a U.S.-based medical student who volunteered with MINDS this summer.

MINDS wants to change this attitude with a three-phase program: education through mental health camps, medical treatment, and social reintegration through vocation training. Local staff implement the program in partnership with Sumandeep Vidyapeeth University and Dhiraj General Hospital in 19 villages around Vadodara in the northwestern state of Gujarat, says Mr. Appasani, the non-profit’s founder and chief executive officer.

Daxeshbhai, a patient.

The MINDS foundation

“I wanted to get to the core issue of education,” said Mr. Appasani. “The biggest misconception in India is that illiterate patients won’t be able to make their own decisions about consenting to treatment. But I believe if you provide people in rural areas with education about mental health, they’ll actually learn,” he said.

Faith healers are one obstacle Mr. Appasani has encountered in encouraging patients to seek medical treatment. In one case, the parents of an 11-year-old boy with behavioral problems bought string beads from a faith healer for 7,000 rupees ($114), Mr. Appasani said. When this didn’t work, the parents sought medical treatment, which has helped their son, he said.

The difference in medical standards and practices between India and the U.S. is a challenge for volunteers, who are American undergraduate or medical students interested in global health problems.

“Quality research methods are not part of Indian medical school education — it’s still a system of rote learning. I found it difficult to work with one of the residents, who didn’t understand why I wanted to do random sampling instead of handpicking respondents for a survey,” said Ms. Ramanathan.

Her research, on the social determinants of depressive-anxiety disorders among women, entailed asking questions about marital history, violence, safety and autonomy.

She said the female resident, although qualified as a psychiatrist, didn’t seem to think counseling was a requirement for women whose husbands physically or verbally abused them. She adopted a “these things happen here,” attitude, said Ms. Ramanathan.

Despite these problems, the mental health interventions MINDS conducts are having an effect, said Mr. Appasani. “In the field, we see patients getting better. When we go to the villages to visit a patient, the neighbors will come out and say, ‘I saw another person down the street with this symptom, maybe you should go visit them,’ which is the clearest indicator that we’re having an impact,” he said.

While mental health conditions often require several years to treat, medicine can help stabilize a patient. But this needs to be followed with long-term care, Mr. Appasani said. MINDS treats 173 patients for mental illness, he added.

One of the organization’s next steps is to move from general education to modules targeting specific groups, from children to teachers to community health workers, he said. MINDS is also developing a model for community health workers to help patients reintegrate into their communities, and refer new patients to a local hospital for treatment, he added.

“Mental health conditions are difficult to understand because there is so much about the brain that even doctors don’t know… it’s treated as a wishy-washy issue everywhere in the world, but in a society that doesn’t even recognize the problem, and furthermore in a rural context, it’s a very difficult cause to take on,” said Ms. Ramanathan.

Shanoor Seervai is a freelance writer based in Bombay. Follow us on Twitter @WSJIndia.

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